Gun and Suicide: Modifying Role of Mental Health System Characteristics

Objectives: There is some evidence that firearm suicides fluctuate positively with firearm prevalence. In this study we examine (a) whether shall-issue right-to-carry laws of the licensed carrying of firearms increases state firearm suicide rates and then (b) whether the relationship between shall issue licensing laws and suicide varies by the level of state mental health resources and regulations.

Methods: We analyze 31-year state panel data for all U.S. 50 states and District of Columbia for the years 1980-2010. Main outcome measures are total suicide death rates per 100,000 persons and completed firearm and nonfirearm suicides by sex. Main regressors include binary indicators for the presence of shall-issue regulations by state and year and characteristics of state mental health system and policy such as per-capita hospital psychiatric beds (total beds and separately by ownership status), per-capita community mental health spending, mental health parity laws, and interaction terms of the shall-issue indicator and mental health system characteristics . We estimate two-way fixed-effects models controlling for comprehensive covariates and correct standard errors for detected error violations.

Results: The adoption of shall-issue laws on average is not significantly associated with any of the suicide rate outcomes. In general no significant interaction effect of the shall-issue law and mental health system characteristics is found. However, the relationship between the presence of shall-issue laws and male firearm suicide rates varies by the state-level supply of psychiatric beds, especially public psychiatric hospital beds. We estimate a ten-bed increase in public psychiatric hospital beds per 100,000 population—approximately two-fold increase from the 2010 average—may avert 1.5 male firearm suicides per a million population in shall-issue states.

Conclusion: Our findings suggest that although shall-issue right-to-carry laws overall has no significant effect on suicide, the magnitude of the relationship between shall-issue laws and male firearm suicide rates in fact depends on state per-capita number of public psychiatric hospital beds. Our estimate of the magnitude does not seem trivial.  To put our results into perspective, if each shall-issue state increased public psychiatric hospital beds by 20 percent of the 2010 average—2 beds per 100,000 population, this increase would avert 600 firearm suicides for male in affected states.